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Form WC-155 Authorization to Disclose Confidential Workers' Compensation Information - Michigan
What Is Form WC-155?
This is a legal form that was released by the Michigan Department of Labor and Economic Opportunity - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form WC-155?A: Form WC-155 is the Authorization to Disclose Confidential Workers' Compensation Information specific to Michigan.
Q: What is the purpose of Form WC-155?A: The purpose of Form WC-155 is to give an injured worker or their representative permission to disclose their confidential workers' compensation information to specified individuals or organizations.
Q: Who needs to complete Form WC-155?A: The injured worker or their representative needs to complete Form WC-155.
Q: What information is required on Form WC-155?A: Form WC-155 requires the injured worker's name, address, and Social Security number, as well as the names and addresses of the individuals or organizations authorized to receive the information.
Q: Are there any fees associated with submitting Form WC-155?A: No, there are no fees associated with submitting Form WC-155.
Q: How should Form WC-155 be submitted?A: Form WC-155 should be completed and submitted to the Michigan Workers' Compensation Agency either by mail or in person.
Q: How long is Form WC-155 valid for?A: Form WC-155 is valid for one year from the date of signing, unless otherwise specified.
Form Details:
- Released on August 1, 2019;
- The latest edition provided by the Michigan Department of Labor and Economic Opportunity;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form WC-155 by clicking the link below or browse more documents and templates provided by the Michigan Department of Labor and Economic Opportunity.
